ABSTRACT
Objective Obesity leads to osteoarthritis due to increased loading forces on joint cartilage and inflammatory agents released from adipose tissue. In patients with a high body mass index (BMI), during hip and total knee arthroplasty, surgical technical challenges such as longer incisions and wider exposure are encountered, resulting in increased postoperative complications (wound healing problems and infection, venous thromboembolism (VTE)- pulmonary embolism (PE), dislocation, early implant failure) and ultimately decreased patient satisfaction and implant survival. This study investigates whether BMI, height, weight, and patient age are associated with longer incisions in patients undergoing unicondylar knee prosthesis (UKP) placement. Method Between January 2017 and December 2018, 30 patients (29 females and 1 male) who underwent UKP surgery due to medial gonarthrosis were included in the study. The UKP used in the procedures was the Oxford Knee Phase III by Biomet Ltd., UK. The study comprised 43 knees, 13 being bilateral cases, 8 on the right, and 9 on the left. Data regarding the patient's height, weight, BMI, age, and the operated side were collected and compiled. The relationships between these variables and the surgical incision length were statistically analyzed. Results The average age of the patients was 66.3 years, with an average weight and height of 77.6 kg (ranging from 62 to 98 kg) and 167 cm (ranging from 150 to 184 cm), respectively. The lengths of the surgical incisions ranged from 70 mm to 160 mm, with an average length of 124.5 mm. When comparing the incision lengths between the right and left sides, it was observed that the incisions on the left side were longer. The average incision length on the right side was 122.09 mm, while on the left, it was 126.86 mm. Moreover, in the 13 patients who underwent bilateral surgery, this difference in incision length was even more pronounced. The average incision length on the right side was 117.15 mm, whereas on the left, it was 124.23 mm. Bivariate correlation analyses were performed to examine the relationship between the length of the incision and BMI and age. However, no significant relationship was found between the incision length and BMI or age. On the other hand, there was a correlation between the patient's weight values and the incision length (p < 0.05, correlation 0.335). Furthermore, a higher correlation was observed between the patient's height and the incision length (p < 0.01, correlation 0.595). Conclusion The latest advances in surgical techniques and instrumentation have enabled surgeons to perform the procedure using a reliable mini-incision approach. Mid-term evaluation of UKP with mini-incision shows faster recovery and lower morbidity. The findings show that in UKP, the length of the surgical incision is more strongly related to the patient's height than their weight.
ABSTRACT
Total knee arthroplasty (TKA) can become impaired in the functionality of the bone-prosthetic unit for various reasons, thereby leading to prosthetic loosening. For patients with bilateral aseptic loosening, revision knee arthroplasty surgery is usually performed in different sessions. Today, with developing anesthetic techniques, the patients' intraoperative and postoperative additional medical treatment needs are reduced; there is a reduction in complication rates too. Complications such as laryngospasm, bronchospasm, malignant hyperthermia, respiratory depression, postoperative delirium, or cognitive dysfunction can be seen. In the postoperative period, patient satisfaction, with adequate pain control, makes the rehabilitation of the knee is easier and shortens the duration of hospital stay. In addition, the risks of complications such as deep venous thrombosis, pulmonary embolism, pneumonia, and urinary retention are decreased with early rehabilitation, preventing the development of arthrofibrosis. Maximum recovery in the early postoperative period may be possible with the early recovery of movement. Between the years 2017 and 2018, patients admitted to our hospital for bilateral TKA application due to bilateral aseptic loosening and the early results of the application of bilateral revision TKA in one session with four selected patients are compared according to the requirements for blood transfusion and overall costs. Patient selection was shared with the anesthesiologist and the decision to continue bilaterally was made in the intraoperative assessment. In patients who did not develop any pathologies in the initial operation, the second operation was performed, where the risks of the second operation were not taken into account. As a result, we conclude that bilateral revision TKA application on correct patient selection is a surgical procedure that can be performed safely by an experienced team.
ABSTRACT
Oxidative stress is a critical route of damage in various physiological stress-induced disorders, including depression. Rose oil may be a useful treatment for depression because it contains flavonoids which include free radical antioxidant compounds such as rutin and quercetin. We investigated the effects of absolute rose oil (from Rosa × damascena Mill.) and experimental depression on lipid peroxidation and antioxidant levels in the cerebral cortex of rats. Thirty-two male rats were randomly divided into four groups. The first group was used as control, while depression was induced in the second group using chronic mild stress (CMS). Oral (1.5 ml/kg) and vapor (0.15 ml/kg) rose oil were given for 28 days to CMS depression-induced rats, constituting the third and fourth groups, respectively. The sucrose preference test was used weekly to identify depression-like phenotypes during the experiment. At the end of the experiment, cerebral cortex samples were taken from all groups. The lipid peroxidation levels in the cerebral cortex in the CMS group were higher than in control whereas their levels were decreased by rose oil vapor exposure. The vitamin A, vitamin E, vitamin C and ß-carotene concentrations in the cerebral cortex were lower in the CMS group than in the control group whereas their concentrations were higher in the rose oil vapor plus CMS group. The CMS-induced antioxidant vitamin changes were not modulated by oral treatment. Glutathione peroxidase activity and reduced glutathione did not change statistically in the four groups following CMS or either treatment. In conclusion, experimental depression is associated with elevated oxidative stress while treatment with rose oil vapor induced protective effects on oxidative stress in depression.
